AB0218 RHEUMATOID ARTHRITIS OUTCOMES: A MULTICENTRE CROSS-SECTIONAL STUDY OF PATIENTS IN IRELAND (CONTEXT-RA)
Authors: G. Murphy, D. Kane, K. O’rourke, C. Sheehy, F. B. O’shea, R. Conway, D. Veale, A. Camon, D. Moran
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Despite increasing treatment options for RA, many patients still do not appear to achieve remission, especially in more established disease.<sup>[1]</sup> <h3>Objectives</h3> To evaluate disease outcomes and quality of life (QoL) of DMARD treated patients with RA in clinical remission (CR) in routine Irish rheumatology clinics vs those with residual disease activity. <h3>Methods</h3> A multicentre, cross-sectional study with a 9-month recruitment period (Mar-Nov 2021). Demographics, disease activity, patient reported outcomes, comorbidities, workability &amp; healthcare resource utilisation (HRU) data were collected. Patients on a stable dose of any DMARD (&gt; 3 months) were classified according to disease activity state as follows: Responder group 1 (RG1) CR (CDAI≤2.8) Responder group 2 (RG2) CR/ Low Disease Activity (LDA) (CDAI&gt;2.8 -10) &amp; Non-responders (NR) moderate/high disease activity (CDAI&gt;10) <h3>Results</h3> 130 RA patients were recruited (Table 1). 69% were female, mean age of 60.1 yrs and disease duration of 11.5 yrs. There was no significant difference in seropositivity between responder and non-responder groups (~75% RF+, ~69% ACPA+), 69% were treated with advanced therapy (biologic/targeted synthetic DMARDs), primarily TNFi's. 26% of patients were in CR, 32% in LDA &amp; 42% NR. Significant differences in QoL-primary endpoint were noted between CR/LDA patients vs NR group. The difference in QoL index score (EQ5D-5L) for patients in CR and LDA vs those in remission alone, suggest QoL is considerably higher in patients in CR compared even to those in LDA. Joint pain (VAS), fatigue (FACIT-F) and function (HAQ-DI) scores all yielded strong negative correlations, indicating that CR/LDA patients had significantly better outcomes than those with MDA/HDA (Figure 1). A similar pattern was seen amongst patients in CR vs LDA, although significance was not achieved. In addition, more impaired productivity was noted in NR vs CR/LDA regarding ability to work and perform regular 'non-work' activities. Comorbidities were common, affecting over 90% of the non-responder group and 74% of patients in CR. The NR group had higher proportions of patients with cardiac, gastrointestinal, psychiatric and vascular disorders vs patients in CR/LDA. With respect to HRU, more patients in the NR group required medical visits for both RA and non-RA reasons vs patients in CR/LDA. Of the 54 patients in MDA/HDA, the study found there was a plan to add or switch DMARD, for only 32% of patients. <h3>Conclusion</h3> Overall, these data support the treat-to-target approach of striving for remission in RA, with important differences reported between non-responder &amp; responder groups 1 &amp; 2 but additionally between patients achieving CR vs LDA. The relatively low % of non-responder patients with a documented 'action plan', suggests improved approaches to shared decision making are warranted for patients not yet at the agreed target. <h3>Reference</h3> [1] Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, Combe B, Cutolo M, de Wit M, Dougados M: Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010, 69: 631-637. <h3>Acknowledgements</h3> The authors wish to thank O4 Research for management of study site activity, assistance with the design of the case report form, data management, and preparation of the clinical study report. The financial support for this was provided by AbbVie as per contract. The authors acknowledge Ms Phil Gallagher, Ms Hannah Darcy, Ms Denise Breen, Dr Diana Gheta and UCC CRF in Cork and Waterford, for recruiting patients to this study; financial support for CRF was provided by AbbVie as per contract. <h3>Disclosure of Interests</h3> Grainne Murphy Consultant of: Has served as a consultant to AbbVie in the conduct of the CONTExT-RA study and has received research funding for the study from AbbVie., David Kane Consultant of: served as a consultant to AbbVie in the conduct of the CONTeXT-RA study, and have received research funding for the study from AbbVie., Killian O'Rourke Consultant of: Served as a consultant to AbbVie in the conduct of the CONTeXT-RA study, and has received research funding for the study from AbbVie, Grant/research support from: educational bursaries to travel to national and international conferences from MSD, UCB, Roche, Novartis and Jannsen"., Claire Sheehy Consultant of: "I have served as a consultant to AbbVie in the conduct of the CONTeXT-RA study, and have received research funding for the study from AbbVie; I have served on an advisory board to Janssen.", Finbar Barry O'Shea Consultant of: served as a consultant to AbbVie in the conduct of the CONTeXT-RA study, and has received research funding for the study from AbbVie, Richard Conway Speakers bureau: Janssen, Roche, Sanofi, Abbvie, Pfizer, Novartis, Galapagos, Consultant of: served as a consultant to AbbVie in the conduct of the CONTeXT-RA study, and has received research funding for the study from AbbVie, Grant/research support from: Janssen, Douglas Veale Shareholder of: shareholder of Health Beacon, Speakers bureau: Speakers Bureau for AbbVie, BMS, Celgene, Galapagos, Gilead, Janssen, Pfizer, MSD, UCB., Consultant of: Has served as a consultant to AbbVie in the conduct of the CONTExT-RA study and has received research funding for the study from AbbVie. Consultant/Advisor to AbbVie, Actelion, BMS, Galapagos, Gilead, Janssen, Novartis, Pfizer, MSD, Regeneron/Sanofi, UCB, Grant/research support from: Grant/Research funding from AbbVie, Amgen, Eli Lilly, Novartis, MSD, Pfizer, Janssen, UCB, Angela Camon Consultant of: Advisory boards with Abbvie, Roche ad Consilient and Amgen, Grant/research support from: education bursaries to attend national and international conferences from Abbvie, Roche, MSD, Nordic and Pfizer, Deirdre Moran Shareholder of: Shares in AbbVie, Employee of: Employee of AbbVie.